Letter to the editor re: Worsening disability status in multiple sclerosis predicts urologic complications. Int Urol Nep
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UROLOGY - LETTER TO THE EDITOR
Letter to the editor re: Worsening disability status in multiple sclerosis predicts urologic complications. Int Urol Nephrol. May; 52(5):859–863. doi: 10.1007/s11255‑020‑02381‑6. Epub 2020 Jan 25 by Abello et al Michael S. Floyd Jr.1 · Rauf N. Khadr1 · Carolyn A. Young2,3 Received: 13 May 2020 / Accepted: 20 June 2020 © Springer Nature B.V. 2020
Editor, We read with interest the recent publication by Abello et al. detailing the progression of neurological symptoms in multiple sclerosis (MS) patients and the subsequent deterioration in urological symptoms [1]. The results of a 13 year retrospective study involving 161 multiple sclerosis patients under urological care are presented with a median follow up of 9.7 years [1]. The authors state that the key aims were to identify changes in urodynamic patterns and identify the risk factors for urological complications over time. The urological follow up of patients is listed and specifically mentions disability assessment and symptoms. The authors should acknowledge that although an assessment of disability was achieved with the Expanded Disability Status Scale (EDSS) the study did not utilise any validated questionnaires to specifically assess the urological symptoms associated with MS. Both the neurogenic bladder symptom score (NBSS) and Short Form Qualiveen questionnaire (SFQ) are used in neurogenic bladder patients to assess symptoms and quantify urinary specific quality of life concerns. [2, 3]. Specific to multiple sclerosis the SF Qualiveen has been validated across Europe [4, 5] and recently the * Michael S. Floyd Jr. [email protected] Rauf N. Khadr [email protected] Carolyn A. Young [email protected] 1
Department of Neurourology and North West Spinal Cord Injury Unit, Southport and Ormskirk Hospital NHS Trust, Town Lane, Liverpool PR8 6PN, UK
2
University of Liverpool, Liverpool, UK
3
Department of Neurology, Walton Centre NHS Foundation Trust, Lower lane, Liverpool L9 7LJ, UK
NBSS has been modified to produce a short form which has been used in MS patients [6]. In our unit, all newly referred MS patients undergo baseline assessment with an SF Qualiveen score and following an intervention or treatment are reassessed in an effort to evaluate treatment response [7, 8]. In this study the authors appear to derive the risk of urological complications from the EDSS in isolation. The authors do not state if any patients were asked to stop bladder related medications prior to urodynamic assessment. They acknowledge that urodynamic evaluation was usually performed post intervention or treatment which may not have accurately characterised the urodynamic finding. Additionally, the length of time between urodynamic assessments is not mentioned. The authors state that major complications were uncommon during long term follow-up but from table 3 the cumulative rate for sepsis, acute and chronic renal compromise was 18.5%. This is a significant morbidity particularly in combination with incurable neurological disease. F
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